14D0993489 CLIA NUMBER - CHICAGO PEDIATRIC CLINIC CORPORATION

Laboratory Demographics

  • CLIA Code: 14D0993489
  • Facility Name: CHICAGO PEDIATRIC CLINIC CORPORATION
  • Facility Address: 1916 W IRVING PARK RD
    CHICAGO, IL
    ZIP 60613
  • Facility Phone: 773 477-4900
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: DARLENE EGUES
  • NPI Number: 1780724898
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 14D0993489
LAB Type Community Clinic
Facility Name CHICAGO PEDIATRIC CLINIC CORPORATION
Street 1916 W IRVING PARK RD
City CHICAGO
State IL
ZIP 60613
Phone 773 477-4900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/15/2023
Certificate Expiration Date 11/14/2025
Facility Type Community Clinic
Lab Director DARLENE EGUES

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This page was last updated on: 9/29/2025